帕利哌酮联合右佐匹克隆治疗精神分裂症伴睡眠障碍疗效及对患者神经功能睡眠质量血清催乳素C反应蛋白的影响

Effects of paliperidone combined with dexzopiclone in the treatment of schizophrenia with sleep disorders and on neurological function,sleep quality,serum PRL and CRP

目的探讨帕利哌酮联合右佐匹克隆治疗精神分裂症伴睡眠障碍疗效及对患者神经功能、睡眠质量、血清催乳素(PRL)、C反应蛋白(CRP)水平的影响。方法选取2021年7月至2023年12月丽水市第二人民医院收治的精神分裂症伴睡眠障碍患者92例,按治疗方法分为联合组(46例,奇号)和对照组(46例,偶号),对照组服用帕利哌酮联合劳拉西泮治疗,联合组服用帕利哌酮联合右佐匹克隆治疗,于治疗前和治疗4、8和12周后评估2组精神分裂症状[采用阴性和阳性症状量表(PANSS)]评分变化,神经功能治疗前后变化[蒙特利尔认知评估量表(MoCA)和简易精神状态评定表(MMSE)]、睡眠质量改善情况[匹兹堡睡眠质量指数(PSQI)]、脑神经营养指标变化[脑源性神经营养因子(BDNF)、神经营养因子3(NT-3)、多巴胺(DA)、5-羟色胺(5-HT)]水平及血清催乳素(PRL)、C反应蛋白(CRP)水平变化,统计治疗期间不良反应情况。结果治疗4周、8周、12周后,2组PANSS评分均逐渐降低,组内不同时间点比较,差异有统计学意义(P<0.05),且联合组治疗4周(46±5)、8周(40±4)及12周(32±4)后低于对照组(48±5、42±4、34±4,P<0.05);治疗12周后,2组患者MoCA、MMSE评分均下降(P<0.05),且联合组[MoCA(12.5±1.5)、MMSE(12.1±1.0)]低于对照组[MoCA(18.2±2.0);MMSE(17.6±1.6)](P<0.05);治疗12周后,2组患者PSQI评分均下降(P<0.05),且联合组[睡眠质量(0.85±0.12);入睡时间(0.98±0.24);睡眠时间(0.97±0.18);睡眠效率(0.86±0.14);睡眠障碍(0.88±0.07);日间功能(0.79±0.18)]低于对照组[睡眠质量(1.02±0.47);入睡时间(1.04±0.34);睡眠时间(1.05±0.38);睡眠效率(1.03±0.56);睡眠障碍(1.01±0.41);日间功能(1.01±0.57)](P<0.05);治疗12周后,2组血清BDNF、NT-3、DA、5-HT含量均高于治疗前(P<0.05),且联合组[BDNF(4715±138)ng/ml,NT-3(179±18)ng/ml,DA(71±7)ng/ml,5-HT(44±7)ng/ml]明显高于对照组[BDNF(4218±162)ng/ml,NT-3(150±16)ng/ml,DA(61±6)ng/ml,5-HT(36±5)ng/ml](P<0.05);治疗12周后,2组血清PRL和CRP水平均高于治疗前(P<0.05),PRL组间[联合组(64±11)ng/ml,对照组(67±10)ng/ml]比较差异无统计学意义(P>0.05),但治疗12周后联合组CRP(53±6)mg/L水平低于对照组(56±6)mg/L(P<0.05);联合组总发生反应发生率(8%)低于对照组(26%)(P<0.05)。结论相较帕利哌酮联合劳拉西泮,帕利哌酮联合右佐匹克隆能更好缓解精神分裂症伴睡眠障碍患者的精神分裂症病情程度、改善其睡眠障碍、提高脑神经营养因子水平,值得应用。

Objective To explore the efficacy of paliperidone combined with dexzopiclone in the treat-ment of schizophrenia with sleep disorders and its effects on neurological function,sleep quality,serum prolactin(PRL)and C-reactive protein(CRP).Methods A total of 92 patients with schizophrenia and sleep disorders ad-mitted to Lishui Second People′s Hospital from July 2021 to December 2023 were selected as the study subjects.They were divided into a combination group(n=46)and a control group(n=46),according to different treatment methods.The control group was treated with paliperidone combined with lorazepam while the combined group were given paliperidone combined with dexzopiclone.Before the treatment and after 4 weeks,8 weeks and 12 weeks of the treatment,evaluate the changes of these symptoms:the schizophrenic symptoms[Positive and Nega-tive Syndrome Scale(PANSS)],neurological function[Montreal Cognitive Assessment(MoCA),Mini-Mental State Examination(MMSE)],sleep quality[Pittsburgh Sleep Quality Index(PSQI)],brain neurotrophic indicators[brain-derived neurotrophic factor(BDNF),neurotrophin-3(NT-3),dopamine(DA),5-hydroxytryptamine(5-HT)],levels of serum PRL and CRP.The adverse reactions during treatment were counted.Results After 4 weeks,8 weeks and 12 weeks of the treatment,the PANSS scores of the two groups were gradually decreased,and there was a statisti-cal difference at different time points within the same group(P<0.05).The scores after 4 weeks,8 weeks and 12 weeks of the treatment in the combination group[(46±5)points,(40±4)points,and(32±4)points]were significant-ly lower than those in the control group[(48±5)points,(42±4)points,and(34±4)points](P<0.05).After 12 weeks of the treatment,the MoCA and MMSE scores of both groups of patients significantly decreased(P<0.05),and the scores in the combination group[MoCA(12.5±1.5);MMSE(12.1±1.0)]were significantly lower than those in the control group[MoCA(18.2±2.0);MMSE(17.6±1.6)](P<0.05).After 12 weeks of treatment,the PSQI scores of both groups of patients significantly decreased(P<0.05),and the sleep quality,sleep time,time falling into sleep,sleep efficiency,sleep disorders,daytime function in the combined group[0.85±0.12;0.98±0.24;0.97±0.18;0.86±0.14;0.88±0.07;0.79±0.18] was significantly lower than those in the control group sleep quality[(1.02±0.47)sleep time;(1.04±0.34)time falling into sleep(1.05±0.38);sleep efficiency(1.03±0.56);sleep disorders(1.01±0.41);daytime function(1.01±0.57)](P<0.05).After 12 weeks of treatment,the levels of serum BDNF,NT-3,DA and 5-HT in the two groups were higher than those before treatment(P<0.05),and the levels in combination group(4715±138 ng/ml,179±18 ng/ml,71±7 ng/ml,44±7 ng/ml)were significantly higher compared with those in the control group(4218±162 ng/ml,150±16 ng/ml,61±6 ng/ml,36±5 ng/ml)(P<0.05).After 12 weeks of the treat-ment,the levels of serum PRL and CRP in both groups were higher than those before the treatment(P<0.05).There was no significant difference in PRL between the two groups[combination group(64±11)ng/ml;control group(67±10)ng/ml](P>0.05),but the level of CRP in the combined group was lower than that in the control group(53±6)mg/L vs(56±6)mg/L,P<0.05.The total incidence rate of in the combination group(8%)was signifi-cantly lower than that in the control group(26%)(P<0.05).Conclusion Compared to the combination of paliperidone and lorazepam,the combination of paliperidone and dexzopiclone can better alleviate the severity of schizophrenia in patients with sleep disorders,improve their sleep disorders,and increase brain neurotrophic fac-tor levels.It is worth applying.